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flgnlfl''I .k r i � NI Please print or type.(Form designed for use on elite 12- itch t ( 2-pitch)typewriter.)) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency ResponsePhone 4.Manifest Tracking Number WASTE MANIFEST CAL000409953 i 8775772669 010176114 rLE 5.Generator's Name and Mailing Address Generators Site Address(if different than mailing address) 8anfield Pet Hospital #1164 Danfield Pet HosRita1#1164 2098329373 2477 Nagiee Rd 2477 Naglee Rd Generators Phone: Tracy, CA 95304 _f' GA 95304 6.Transporter 1 Company Name U.S.EPA ID Number Steric cle Specialty Waste Solutions Inc MNS000110924 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address 21st Century EMN, LLC U.S.EPA ID Number 2095 Newlands Dr. East Fernley, NU 89408 Facility's Phone: - c.-, 9a, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit , HM and Packing Group(if any)) 13.Waste Codes No. Type Quantity Wt./Vol. 1. o X UN3249, Waste Medicine, solid, toxic, n. o. s. i CF 00005 p 311 D010 D011 (Selenium, Silver), 6. 1, PG II, FRG#151 LU UJ X 2UN2810, Waste Toxic, liquids, organic, n. o. s. i CF 00004 1° 311 D005 D024 (Barium, M-Cresol), 6. 1, AG Il, ERG#153 3. 4. c 14.Special Handling Instructions and Additional Information 1. 109331 (Rx Toxic Solids) 2. 110583(Rx Toxic Liquids) 15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. It I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if m a small q4titity generator)is true. Generators/Offeror's Printed/Type ame igna ure on ay ear V L L AIA Y 1 021 2 " 1 -1 16.Intema6o Shipments Z ❑Import to U.S. ❑Export from U.S. 15eaing try/exit: Transporter signature for exports only): U.S.: W 17.Transporter Acknowledgment of Receipt of Materials �i Transporter 1 Printed/I yped Name at ont ay ear o Phil Marcie1 aa 021 281201 Transporter 2 Printed/Ty N Signature Month Day Year F r 18.Discrepancy J 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U a LL- Facility's Phone: Lo 18c.Signature of Alternate Facility(or Generator) Q Month Day Year z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 0 1. 2, 3. 4 20.Designated Facility Owner or Operator:Certification of receipt of hazar ous materials covered by the manifest except as noted in Item 18a PrintedlTyped Name ° Signature nr I A Month Day Year 1 / v t EPA Form 8700-22(Rev.3-05) Previous edtions obsolete. DESIGNATED FAr TO DESTINATIONS E(IF REQUIRED) 8700-22 12N3 CA49,10 01,70 5410603 _ 041_+ 522582 M P1102-Ai A �nora�at a